泊沙康唑
医学
内科学
毛霉病
造血干细胞移植
唑
棘白菌素
两性霉素B
外科
挽救疗法
移植
胃肠病学
氟康唑
抗真菌
化疗
皮肤病科
作者
Matthew A. Miller,Kyle C Molina,Jonathan A. Gutman,Sias Scherger,Jessica Lum,Sherif B. Mossad,Mary Jo Burgess,Matthew P. Cheng,Sally Chuang,Samantha E. Jacobs,Dante P. Melendez,Dimpy P. Shah,Andrea Zimmer,M. Rizwan Sohail,Sadia Syed,Randall C. Walker,Eric M. Poeschla,Maheen Z. Abidi
摘要
The survival benefit of combination antifungal therapy for invasive mucormycosis (IM) in patients with hematologic malignancy (HM) and hematopoietic cell transplant (HCT) is not well defined.This multicenter, retrospective study included HM and HCT recipients with proven or probable IM between January 1, 2007 and December 31, 2017 from 10 transplant centers across North America.Sixty-four patients with proven (n = 47) or probable (n = 17) IM defined by 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) consensus definitions were included. Thirty-nine (61%) were HCT recipients (95% allogeneic). Sites of infection included rhino-orbital-cerebral (33), pulmonary (30%), disseminated (19%), gastrointestinal (3%), and cutaneous (3%). Surgical debridement was performed in 66%. Initial antifungal treatment consisted of the following: lipid formulation of amphotericin B (AmB) alone (44%), AmB + posaconazole (25%), AmB + echinocandin (13%), AmB + isavuconazole (8%), posaconazole alone (5%), and isavuconazole alone (3%). All-cause mortality at 30 days and 1 year were 38% and 66%, respectively. Initial treatment with AmB plus posaconazole or isavuconazole (n = 28) was associated with a trend toward lower treatment failure compared with AmB (n = 21) (42% vs 64%, P = .136).Long-term survival with IM among HM and HCT populations remains poor. However, initial use of AmB + azole in conjunction with surgery may result in less treatment failure. More evidence from prospective controlled studies is needed to confirm this observation.
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